New Mexico Study of Strangulation Deaths Points to Value of CT Scans at Autopsy

The National Institute of Justice published a recent paper citing the use of computed tomography (CT) scans to speed up work amidst a staggering case load of death in America—and to even catch postmortem details that may have gone unnoticed under the scalpel and microscope. Forensic Magazine spoke this week to officials who said there is a need for research to understand how it may make the science better.

The CT scans caught hyoid fractures in strangulation deaths that otherwise went undetected during autopsies, according to a study by the New Mexico Office of the Medical Investigator and the University of New Mexico, which appeared recently in the Journal of Forensic Sciences.

They conclude, from a meta-analysis of 16 studies, and their own investigations, that CT scans can catch details that are otherwise overlooked.

“While (postmortem CT scans) may not detect soft tissue injuries in decomposed remains or subtle internal hemorrhage in neck injury, it is equally able to detect bony injuries as autopsy and might surpass autopsy in detecting subtle fractures,” they write. “We conclude (post-mortem CT) is useful to supplement autopsy in strangulation cases.”

The papers from the literature showed 576 autopsy results, and six that were performed with CT scans.

The new New Mexico work showed 130 deaths with autopsy findings, and 14 with both autopsy and CT scans compared in the same examinations, write the scientists.

The manual strangulations showed more fractures if the hyoid, thyroid and cricoid cartilages, as well as soft tissue hemorrhages, the pathologists write.

The CT scans caught things that went missed, they added.

“Our study demonstrates that, in the evaluation of strangulation deaths, (postmortem CT) is equally able to elucidate the essential internal injuries of the bony neck structures and may be superior to autopsy-only examinations in the detection of small and difficult to visualize fractures,” they write. “While (postmortem CT) should not replace autopsy examination in cases of homicide, it could be used to more fully document internal bony injuries in accidental or suicidal cases that might otherwise only receive an internal examination.”

But they also highlight the limitations—including establishing access to forensic radiologists, the scientists write. Also key is how relatively rare strangulation deaths are to make statistical conclusions, and also the specific selection of strangulation cases out of thousands that appeared in the literature and in New Mexico morgues, they add.